| ObjectiveTo develop a health education program based on Information-Motivation-Behavioral Skills Model(IMB model),and explore the influence of the program on the health literacy of maintenance hemodialysis patients.Method1.Before the intervention,a research team was set up to analyze the research status of the health literacy of maintenance hemodialysis patients on the basis of literature review,and the first draft of the health education program for maintenance hemodialysis patients based on the IMB model was constructed.The intervention program was revised through expert group meetings and preliminary experiments,and the final draft of the health education program based on the IMB model was finally determined.2.Ninety patients meeting the inclusion criteria who received maintenance hemodialysis(MHD)treatment in the Blood purification center of a 3A hospital in Qingdao from August 1,2020 to October 31,2020 were selected and divided into control group and observation group with 45 patients in each group according to random number table method.The control group received routine health education,and the observation group received personalized health education based on IMB theoretical model.General data of the patients were collected before intervention;the hemodialysis patient health literacy questionnaire,hemodialysis knowledge level questionnaire,chronic disease self-efficacy scale and hemodialysis patient self-management scale of the two groups were collected before intervention,3 months and 6 months after intervention,respectively;some laboratory indicators of the two groups were collected before intervention and 3 months after intervention.The baseline data before intervention were analyzed,and the differences in health literacy,hemodialysis related knowledge level,self-efficacy and self-management scores between the two groups were compared 3 months and 6 months after intervention,and the differences in some laboratory indicators between the two groups after 3 months of intervention were compared.Result1.Through literature research,expert group meetings and preliminary experiments,finally determine the health education program based on IMB model.2.A total of 90 MHD patients were enrolled in this study before intervention.During the study,due to reasons such as automatic withdrawal,transfer and death of patients,1 case was lost to follow-up in the observation group,2 cases were lost to follow-up in the control group,and a total of 3 cases were lost,with a total loss rate of 3.3%.A total of 87 patients participated in the whole study process.(1)Comparison of baseline data: Before intervention,general and disease-related data,total score of health literacy questionnaire and scores of each dimension of hemodialysis patients,score of hemodialysis knowledge level questionnaire,score of chronic disease self-efficacy scale,total score of self-management scale for hemodialysis patients and scores of each dimension,standard attainment rate of some serum electrolytes(serum potassium,calcium,phosphorus)and nutrition indicators(serum albumin,hemoglobin)of the two groups of patients were investigated and found no statistical difference(P>0.05).(2)Comparison of hemodialysis related health literacy: Repeated measures of variance were used to compare the total score of health literacy at different time points and scores of each dimension,and it was found that intervention effect,time effect and intervention-time interaction effect were all P<0.05.Inter-group comparison showed that at 3 and 6 months after intervention,the total score of health literacy and three dimensions in the observation group were significantly higher than those in the control group(P< 0.05);The total score of health literacy and scores of all dimensions of the two groups were gradually improved over time,but the improvement range of the observation group was higher than that of the control group.Within group comparison,the scores of interactive health literacy in the two groups and functional health literacy in the control group were not significantly improved at 6months after intervention compared with 3 months after intervention(P>0.017),the total score of health literacy and the scores of other items in the two groups were increased at 3and 6 months after intervention compared with before and after intervention,with statistical difference(P < 0.017).(3)Comparison of hemodialysis knowledge: Repeated measures of variance were used to find that there were significant intervention effects,time effects and intervention-time interaction effects in the questionnaire scores of hemodialysis knowledge in the two groups(P< 0.05);The scores of hemodialysis knowledge at 3 months and 6 months after intervention were significantly different between the observation group and the control group(P<0.05);The score of related knowledge level of hemodialysis in two groups increased gradually over time,but the increase of score in observation group was higher than that in control group.Within the group comparison,there were statistically significant differences in the scores of hemodialysis related knowledge level between the two groups at each time point(P < 0.017).(4)Self-efficacy comparison: Repeated measurement variance analysis was performed on the scores of chronic disease self-efficacy of the two groups at different time points before and after the intervention,and the results showed that intervention effect,time effect and interaction effect were all P<0.05;Inter-group comparison showed that the self-efficacy scale scores of the observation group were significantly higher than those of the control group at 3months and 6 months after intervention(P<0.05);The self-efficacy scale scores of the two groups increased gradually over time,but the increase of the scores of the observation group was higher than that of the control group.In intra-group comparison,pairwise comparison of self-efficacy scale scores between the two groups showed statistically significant differences at each time point(P < 0.017).(5)Comparison of self-management behavior: Repeated measure analysis of variance was used to compare the total score of self-management scale and scores of each dimension of the two groups of patients at different time points before and after the intervention.It was found that the intervention effect,time effect and interaction effect were all P<0.05;Compared with the control group,there were significant differences between the observation group and the control group in the total scores of the self-management scale at 3 months and6 months after intervention(P<0.05);The total score of the self-management scale and the scores of each dimension of the two groups increased gradually over time,but the increase of the score of the observation group was higher than that of the control group.Within the group comparison,pairwise comparison of the total score of the self-management scale and scores of each dimension in the two groups at each time point showed statistically significant differences(P < 0.017).(6)Comparison of some laboratory indexes: After 3 months of intervention,it was found that the rate of serum electrolytes(serum potassium,serum calcium,serum phosphorus)up to the standard and nutritional indexes(serum albumin,hemoglobin)in the observation group were significantly higher than those in the control group(P<0.05),and the difference was statistically significant.Conclusion1.The analysis of hemodialysis related knowledge level,self-efficacy,health literacy,and self-management status of MHD patients before intervention is not ideal,and patients need to provide information support,motivation and behavioral skills support.2.The health education program for MHD patients based on IMB model is scientific and reasonable.This intervention study has proved that it can improve the health literacy level of MHD patients,promote patients to actively acquire health knowledge,enhance self-efficacy,and thus better self-management of disease.3.Education based on IMB model can reduce blood potassium level and improve calcium and phosphorus metabolism and nutritional status of MHD patients. |
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